Benchmarking: applications to transfusion medicine

Benchmarking is ‘a structured, continuous, collaborative process in which comparisons for selected indicators are used to identify factors which when implemented will improve transfusion practices’. In the Transfusion Medicine literature, there are only a few published articles that meet the criteria for benchmarking: (1) using comparisons between institutions to identify practice variation; (2) using a communication and/or evaluation process to identify factors associated with best practices; (3) introduce best practice factors into one's own setting; and (4) re-evaluate performance. Three models for benchmarking have been proposed: (1) a regional benchmarking programme that collects and links relevant data from existing electronic sources; (2) a sentinel site model where data from a limited number of sites are collected; and (3) an institutional-initiated model where a site identifies indicators of interest and approach other institutions as comparators. Finland has the most well-developed benchmarking model where hospital data are collected electronically from multiple sources and analysed centrally with web-based reports available for participants. Areas of practice variation are explored in annual benchmarking workshops, interventions are identified and implemented, and the impact of the interventions are evaluated at a later date. A provincial model used in Canada will also be described showing the impact on red cell outdating when hospitals were challenged to meet evidence based targets. Limitations of benchmarking and future research will be discussed.     

How willing are dentists to treat young children?: A survey of dentists affiliated with Medicaid managed care in New York City, 2010

BackgroundDespite recommendations for children to have a dental visit by the age of 1 year, access to dental care for young children, including children enrolled in Medicaid, remains limited. The authors conducted a survey to assess the availability of dentists to see young children enrolled in Medicaid managed care (MMC) in New York City (NYC), to determine barriers to the provision of dental care to young children and, within the context of MMC, to identify strategies to facilitate the delivery of dental care to children.MethodsThe authors mailed a survey to assess the provision of dental services to young children and perceived barriers and facilitators to 2,311 general dentists (GDs) and 140 pediatric dentists (PDs) affiliated with NYC MMC. A total of 1,127 surveys (46 percent) were received. The authors analyzed the responses according to provider type, youngest aged child seen, provider’s ability to see additional children and practice location. The authors compared responses by using the χ² test.ResultsFewer than one-half (47 percent) of GDs saw children aged 0 through 2 years. Provider type, years in practice and percentage of Medicaid-insured patients were associated significantly (P χ .005) with youngest age of child seen. Among respondents seeing children aged 0 through 2 years, PDs were significantly more likely to provide preventive therapy (P = .004) and restorative treatment (P χ .001). Additional training and access to consulting PDs were identified by GDs as potential facilitators to seeing young children.ConclusionA high proportion of NYC GDs affiliated with MMC do not see young children.Practice ImplicationsNinety-four percent of NYC MMC– affiliated dentists are GDs, but 53 percent of GD respondents did not see children aged 0 through 2 years in their practices. Improving access to dental care for young children requires changes in GDs’ practices, possibly by means of additional training and access to consulting PDs.     

Association between perceived oral and general health

Objectives

The aim of this study was to determine the magnitude of the association between perceived oral and general health-related quality of life (O/HRQoL) in the German general population and to compare it with the correlation of both constructs in dental patients.

Methods

OHRQoL was assessed using the OHIP-49 and HRQoL using the SF-36 in a sample (N = 811) representative of the adult general population of Germany (age: 18–99 years), and in a sample (N = 313) of consecutive adult dental patients at least 18 years of age seeking prosthodontic care or attending their annual checkup. Correlation between OHRQoL and HRQoL was computed using structural equation modelling-based confirmatory factor analysis and path analysis. Based on the correlation coefficients, the coefficients of determination (r²) were calculated.

Results

Correlation between OHRQoL and HRQoL after partialling out effects of age, gender and level of depression in general population subjects was rho = 0.28 resulting in an explanation of the variance of HRQoL by OHRQoL of 7.8%. In dental patients the correlation coefficient was somewhat lower (rho = 0.24) corresponding to an explanation of the variance of HRQoL by OHRQoL of 5.6%. Difference between correlation coefficients was not significant (p = 0.514).

Conclusion

Our findings provide evidence for the inseparable, intertwined relationship between perceived oral and general health.     

Health-related quality of life changes following major and minor hepatic resection: the impact of complications and postoperative anemia

Background

Few studies have evaluated the health-related quality-of-life (QOL) changes in patients following major liver resection for malignancy.

Methods

QOL parameters were recorded prospectively at baseline (preoperative), and through 6 months of follow-up using various instruments.

Results

Major complications occurred in 10 of 41 patients. At the initial outpatient visit, patients reported decreased global QOL with increased fatigue compared with baseline, which normalized at 6 weeks' follow-up and remained stable at 6 months. Those with major complications reported increased severity of pain over baseline at initial follow-up and at 6 months. Patients anemic at the time of discharge had worse physical QOL at 6 weeks, but levels similar to nonanemic patients at 3 months.

Conclusions

Major complications are associated with increased reporting of pain persisting at 6 months. Attention to pain control, especially among patients with major complications, may improve QOL after major hepatic resection.     

12-Month generic health status and psychological distress outcomes following an Australian natural disaster experience: 2009 Black Saturday Wildfires

Objective

To describe the generic health status, health-related quality of life and psychological distress over a 12-month period of burns patients affected by the 2009 Black Saturday Wildfires.

Design setting and participants

Cohort study with retrospective assessment of pre-injury status and prospective assessment of physical and psychosocial functioning in the Black Saturday Wildfires burns patients across time. Generic health status and burn specific quality of life using the 36-item Short Form Health Survey (SF-36) and Burn Specific Health Scale (BSHS) were collected at three, six and twelve months post-burn injury. In addition, similar time points were used to measure level of psychological distress and the presence of pain using the Kessler-10 questionnaire (K-10) and the McGill Pain Questionnaire.

Results

At 12 months post-injury, patients reported a mean 16.4 (standard error, SE: 3.2) reduction in physical health and a 5.3 (SE 2.5) reduction in mental health scores of the SF-36 as compared to their pre-injury scores, with significant decreases observed in the “bodily pain”, “physical functioning”, “role physical” and “vitality” subscales. High levels of psychological distress and persistent pain were experienced, with no significant changes during the study period to the overall burns specific quality of life.

Conclusions

Even 12 months post-burn injury, patients affected by the 2009 Victorian Wildfires still experienced a significant reduction in generic health, increased psychological distress and persistent pain. The need for early and ongoing identification of physical and psychosocial impairments during hospital admission and upon discharge could be helpful to establish systematic interdisciplinary goals for long-term rehabilitation after severe burn injury.     

Synergistic effect of age and body mass index on mortality and morbidity in general surgery

Background

The elderly population (aged 65 y and older) is expected to be the dominant age group in the United States by 2030. In addition, the prevalence of obesity in the United States is growing exponentially. Obese elderly patients are increasingly undergoing elective or emergent general surgery. There are few, if any, studies highlighting the combined effect of age and body mass index (BMI) on surgical outcomes. We hypothesize that increasing age and BMI synergistically impact morbidity and mortality in general surgery.

Materials and methods

We collected individual-level, de-identified patient data from the Michigan Surgical Quality Collaborative. Subjects underwent general surgery with general anesthetic, were >18 y, and had a BMI between 19 and 60. Primary and secondary outcomes were 30-d “Any morbidity” and mortality (from wound, respiratory, genitourinary, central nervous system, and cardiac systems), respectively. Preoperative risk variables included diabetes, dialysis, steroid use, cardiac risk, wound classification, American Society of Anesthesiology class, emergent cases, and 13 other variables. We conducted binary logistic regression models for 30-d morbidity and mortality to determine independent effects of age, BMI, interaction between both age and BMI, and a saturated model for all independent variables.

Results

We identified 149,853 patients. The average age was 54.6 y, and the average BMI was 30.9. Overall 30-d mortality was 2%, and morbidity was 6.7%. Age was a positive predictor for mortality and morbidity, and BMI was negatively associated with mortality and not significantly associated with morbidity. Age combined with higher BMI was positively associated with morbidity and mortality when the higher age groups were analyzed. Saturated models revealed age and American Society of Anesthesiology class as highest predictors of poor outcomes.

Conclusions

Although BMI itself was not a major independent factor predicting 30-d major morbidity or mortality, the morbidly obese, elderly (>50 and 70 y, respectively) subgroup may have an increased morbidity and mortality after general surgery. This information, along with patient-specific factors and their comorbidities, may allow us to better take care of our patients perioperatively and better inform our patients about their risk of surgical procedures.     

219例活体肾移植供者长期随访分析

目的 探讨活体肾移植供者术后生存质量及恢复情况.方法 对2004年以来219例肾脏捐献超过1年的亲属活体肾移植供者进行随访,评估供者的肾功能、并发症发生情况及生活质量.结果 供者捐肾时年龄为(43.3±11.6)岁(19～66岁),随访时间为术后12～103个月,随访截止时供者存活率为100％.术后稳定期(1年后)供者血清肌酐(Scr)为(84.0±18.7)μmol/L,内生肌酐清除率(Ccr)为(1.23±0.37)ml/s.＞50岁者术后1周及1年后Ccr低于年龄≤50岁者(P＜0.01,P＜0.05).3例供者术后Scr未降至正常范围,其肾脏捐献时年龄＞55岁.术后并发症包括高血压30例(其中5例为术后新发),镜下血尿4例,高脂血症3例,轻度贫血2例,股骨头坏死1例.总体感觉肾脏捐献对健康有影响者共40例,认为肾脏捐献对健康有轻度影响者31例,有较明显影响者7例,有严重影响者2例;偶尔觉伤口疼痛31例,经常感觉伤口疼痛4例.结论 供者肾脏捐献后中长期安全性和生存质量良好,但仍存在肾功能异常风险,尤其是高龄供者,需密切随访.供者随访依从性需进一步提高.     

氢化物原子荧光法测定水砷的分析质量控制

目的 分析氢化物原子荧光法测定水砷的质量控制并进行误差预测,提高实验室水砷检测能力和质量控制能力,确保检测数据的准确性和可靠性.方法 按水质分析中评价微量元素精密度和准确度的分析质量控制工作程序,用氢化物原子荧光法(GB/T5750.5-2006)对空白溶液(3％盐酸溶液)、2种标准溶液(0.1C、0.9C砷标准溶液,C为分析方法测定范围的上限,本实验C为20.0 μg/L)、天然水样、加标水样(5.0 μg/L)中砷含量进行测定.结果 5种试样的批内、批间变异分析,差异无统计学意义(F＜F0.05,P均＞ 0.05),每种试样的总标准差(S)小于其测定浓度的5％,总平均回收率可信限(R/d)为0.99.能力验证样品实验室内的随机误差(ZWAs)为1.04、实验室间的系统误差(ZBAs)为1.12.质控考核结果为满意.结论 采用精密度和准确度的分析质量控制工作程序对氢化物原子荧光法测定水中砷进行分析质量控制,保证实验结果误差在可控制的范围内,获得高度可信的分析结果.